3.04 Perforated Tympanic Membrane (Ruptured ear drum)
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agk's Library of Common Simple Emergencies

Presentation
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The patient will present with ear pain after 
barotrauma, such as a blow to the ear or 
deep-water diving; or after direct trauma with 
a stick or other sharp object. Hemorrhage will 
often be noticed within the external canal and 
the patient will experience some hearing loss. 
Tinnitus or vertigo may also be present. 
Otoscopic examination will reveal a defect in 
the tympanic membrane that may or may not be 
accompanied by disruption of the ossicles.

What to do:
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- Clear out any debris from the canal, using 
   gentle suction.
- Test for nystagmus and gross hearing loss.
- Place a protective cotton plug inside of the 
   ear canal and instruct the patient to keep 
   the canal dry.
- Prescribe an appropriate analgesic (e.g., 
   ibuprofen, naproxen, acetaminophen with 
   codeine or oxycodone).
- Insure that the patient gets early follow up 
   by an otolaryngologist.

What not to do:
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- Do not instill any fluid into the external 
   canal or allow the patient to get water into 
   his ear. Water in the middle ear is painful, 
   irritating and may introduce bacteria. 
   Covering the cotton plug with petroleum 
   jelly will allow the patient to shower 
   safely.

Discussion
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Small uncomplicated perforations usually heal. 
When there is nystagmus, vertigo, profound 
hearing loss, or disruption of the ossicles, 
then early otolaryngologic consultation is 
advisable.

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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 1.202.237.0971 fax 1.202.244.8393 electra@clark.net
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